BAB 6
SIMPULAN DAN SARAN
6.1
Simpulan
Berdasarkan hasil penelitian yang telah dilakukan, dapat
disimpulkan beberapa hal sebagai berikut:
1.
Umur
Persentase tertinggi pasien rawat inap berada pada kelompok umur
45-49 tahun. Pasien rawat jalan mempunyai persentase tertinggi sebesar
17,46% pada kelompok umur 55-59 tahun. Pada penelitian ini kejadian
hipertensi lebih banyak didapatkan pada kelompok umur > 40 tahun baik
pada pasien rawat jalan maupun rawat inap. Pada pasien rawat inap sebesar
92% dan pada pasien rawat jalan sebesar 92,05%.
2.
Jenis Kelamin
66,7% dari total pasien rawat inap mempunyai jenis kelamin
perempuan; dan dari pasien rawat jalan 63% juga dengan jenis kelamin
perempuan. Berdasarkan perbandingan jenis kelamin dengan kelompok
umur, didapati perempuan > 55 tahun lebih banyak menderita hipertensi
baik pada pasien rawat inap maupun pasien rawat jalan.
3.
Pekerjaan
50% subjek pasien rawat inap tidak mempunyai data tentang
pekerjaan. Pekerjaan yang paling banyak adalah pegawai swasta sebesar
47,2%.
4.
Tingkat Pendidikan
72,2% tidak mempunyai data tingkat pendidikan. Tidak ada data
mungkin disebabkan karena data tidak diambil dari kuesioner atau
wawancara terhadap subjek penelitian. Tamat SD merupakan persentase
terbanyak kedua, dan tingkat universitas merupakan persentase terkecil.
5.
Faktor Risiko
a.
Rokok
86,1% dari total subjek di rawat inap tidak mempunyai data
merokok atau tidak pada rekam medis; dan sebesar 13,9% subjek tidak
merokok, sedangkan pada pasien rawat jalan tidak didapatkan data apakah
subjek merokok atau tidak.
b.
Alkohol
Hasil penelitian didapati 86,1% subjek tidak punya data, dan
13,9% subjek tidak meminum alkohol pada pasien rawat inap. Tidak
didapati ada subjek yang positif minum atau mempunyai kebiasaan minum
alkohol. Pada pasien rawat jalan, tidak didapati data ada subjek yang
menyatakan mempunyai kebiasaan minum alkohol. Banyak tidak ada data
disebabkan karena pengumpulan data hanya didasarkan pada rekam medis.
Pada penelitian ini tidak disebutkan jenis minuman alkohol, karena
penelitian ini tidak menggunakan kuesioner atau wawancara. Namun
sebanyak 5,6% pasien rawat inap dan 3,1% pasien rawat jalan mempunyai
fatty liver.
c.
Obesitas
Hasil penelitian didapati sebanyak 2,8% pasien rawat inap
mempunyai obesitas, sedangkan pada pasien rawat jalan didapati 2,38%
merupakan obesitas dan 1,63% pasien merupakan overweight.
6.
Penyakit Penyerta
a.
Diabetes Melitus
Penyakit diabetes melitus menempati frekuensi penyakit penyerta
terbanyak pada pasien rawat inap dan rawat jalan. Hipertensi lebih sering
didapatkan pada populasi diabetes. Terdapat etiologi dan mekanisme
penyakit yang saling tumpang tindih antara hipertensi dengan diabetes
melitus.
b.
Penyakit Kardiovaskular
Hasil penelitian di Rumah Sakit Gotong Royong menunjukkan
penyakit kardiovaskular menempati peringkat kedua dalam penyakit
penyerta baik pada pasien rawat inap maupun pasien rawat jalan. Hasil
penelitian di Rumah Sakit Gotong Royong, mempunyai frekuensi kejadian
terbanyak ditempati oleh penyakit jantung koroner. Beberapa data pasien
mempunyai
kardiomegali,
tetapi
tidak
dapat
disimpulkan
apakah
kardiomegali tersebut merupakan LVH.
c.
Penyakit Serebrovaskular
Faktor risiko pada stroke iskemik berupa hipertensi; diabetes;
hiperlipidemia; umur diatas 55 tahun; jenis kelamin laki-laki; riwayat
stroke, banyak didapatkan pada hasil penelitian baik pada pasien rawat inap
maupun
rawat
jalan,
sehingga
meningkatkan
kejadian
penyakit
serebrovaskular.
d.
Penyakit Ginjal Kronis
Penelitian ini tidak menentukan apakah hipertensi pada subjek
disebabkan karena PGK atau tidak. Hal ini karena keterbatasan sarana dan
prasarana dalam menentukan hal tersebut. Pada pasien rawat inap, sebanyak
22,2% laki-laki dan 44,4% perempuan mempunyai kreatinin serum tidak
normal. Hasil yang sama juga didapatkan pada pasien rawat jalan laki-laki.
Sebanyak 11,1% mempunyai kreatinin serum tidak normal, sedangkan pada
perempuan didapatkan persentase yang sama. Hasil penelitian BUN baik
pada pasien rawat inap dan rawat jalan menunjukkan sebagian besar masih
berada dalam batas normal.
Hasil penelitian menunjukkan sebagian besar subjek baik rawat
inap dan rawat jalan tidak mempunyai data serum asam urat sehingga tidak
dapat ditarik kesimpulan lebih jauh apakah memang serum asam urat
memiliki pengaruh terhadap hipertensi dan PGK. Hampir sama dengan
asam urat, tidak banyak didapatkan data kadar albumin baik pada pasien
rawat inap dan rawat jalan.
7.
Hipertensi
Hasil penelitian antara pasien rawat inap dan rawat jalan
menunjukkan perbedaan. Pasien rawat inap banyak mempunyai yang
tingkat risiko tinggi; sedangkan pada pasien rawat jalan banyak mempunyai
tingkat risiko sedang.
Faktor risiko yang digunakan dalam penelitian ini adalah: jenis
kelamin laki-laki; umur (perempuan ≥ 65 tahun dan laki-laki ≥ 55 tahun);
merokok; dislipidemia; gula darah puasa 102-125 mg/dL; tes toleransi gula
darah yang abnormal; obesitas; obesitas sentral; ada riwayat keluarga
pernah mengalami kejadian penyakit kardiovaskular (laki-laki < 55 tahun
dan perempuan < 65 tahun). Kerusakan target organ asimptomatis yang
dimasukkan adalah: tekanan nadi pada lansia ≥ 60 mmHg dan apakah ada
mikroalbuminuria. Kerusakan organ simptomatis yang digunakan adalah
diabetes melitus; kejadian serebrovaskular; infark miokardium; gagal
janutng; penyakit ginjal kronis; dan retinopati.
8.
Profil Lemak
Sebagian besar pasien rawat inap dalam penelitian ini mengalami
dislipidemia. Dislipidemia secara luas meliputi abnormalitas pada LDL,
HDL, dan kadar trigliserida. Serum total kolesterol; trigliserida; dan LDL
didapati lebih tinggi pada individu dengan hipertensi dibandingkan dengan
normotensi. Individu dengan hipertensi memiliki kadar HDL yang lebih
rendah dibandingkan normotensi terutama pada perempuan.
6.2
Saran
Berdasarkan penelitian yang telah dilakukan, maka saran yang
dapat disampaikan adalah sebagai berikut:
1.
Hasil penelitian diharapkan dapat meningkatkan kesadaran subjek
penelitian dan masyarakat terhadap hipertensi dan faktor-faktor
risiko.
2.
Hasil penelitian diharapkan dapat dijadikan masukan bagi Rumah
Sakit Gotong Royong dan pelayanan kesehatan lain untuk
melengkapi rekam medis, menyusun program kesehatan untuk
mengendalikan hipertensi, dan faktor-faktor risiko dalam rangka
menurunkan angka kejadian hipertensi.
3.
Hasil penelitian diharapkan dapat dijadikan masukan bagi institusi
pendidikan untuk meningkatkan pengetahuan hipertensi dan halhal yang mempengaruhi hipertensi.
4.
Program promosi kesehatan yang dapat dilakukan kepada subjek
penelitian dan masyarakat sekitar adalah menyebarkan poster dan
mengadakan talk show yang mempromosikan hipertensi, bahaya
hipertensi dan komplikasi, serta promosi gaya hidup sehat lewat
olahraga dan pola makan yang ideal.
5.
Hasil penelitian ini diharapkan dapat dijadikan sebagai dasar
penelitian lebih lanjut.
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